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Riccardo Baschetti, MD
Padua, Italy

JAMA. 1996;275(5):359.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Dr Bou-Holaigah and colleagues¹ observed that nearly half of patients treated with fludrocortisone reported complete or nearly complete resolution of CFS symptoms. Although partial, this response represents good success, if we consider that no previously tried therapy, except licorice,^2,3 has been reported to be consistently effective.

Fludrocortisone is the typical mineralocorticoid supplementation for Addison's disease,⁴ which also has been treated with licorice.⁵ Both this common therapeutic effectiveness and the recently confirmed hypocortisolism in CFS patients⁶ suggest that the NMH that occurs in CFS is a mere consequence of an underlying atypical adrenal insufficiency. Therefore, the failure of fludrocortisone, which has only mineralocorticoid activity,⁴ to resolve symptoms in approximately half of patients who received it in the study by Bou-Holaigah et al¹ simply reflects its lack of glucocorticoid potency. Intuitively, fludrocortisone plus hydrocortisone would have been more effective. In fact, for . . . [Full Text PDF of this Article]

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